Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas Fax APPLICATION FOR ADMISSION

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1 Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas Fax APPLICATION FOR ADMISSION Child s name (last) (first) (middle) (name used) Sex Date of birth Place of birth Social Security Number Parent/Guardian s name Social Security Number Occupation Employer Business address Home address address Home phone Business phone Cell phone Parent/Guardian s name Social Security Number Occupation Employer Business address Home address address Home phone Business phone Cell phone SCHOOL DIRECTORY PERMISSION Yes, I want to be listed in the Weekday School Directory which will include name, address, home telephone number and address. Please list any requested restrictions: No, I do not want to be listed in the Weekday School Directory. Not applicable, summer

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3 Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas Fax Dear Families, This form will be copied and kept in your child s classroom in case of an emergency or in the case of a school evacuation. Thank you for taking the time to fill out the front and back. CHILD S NAME: I authorize the release of my child s health information to the following persons for the immediate care of my child and on an as needed basis: Members of Laurel Heights UMC Weekday School teaching staff who are responsible for my child. Administration and Administrative office staff at Laurel Heights UMC Weekday School. My child s medical physicians and consultants EMS technicians and hospital staff in the event of an emergency Emergency contacts listed on my child s emergency form ad TDFPS form PARENT/GUARDIAN S SIGNATURE DATE PLEASE INCLUDE CHILD S HEALTH INSURANCE INFORMATION FOR EMERGENCY MEDICAL SERVICES. This information is optional. Please check here if you do not want to give health insurance information or if you do not have health coverage. Insurance Name: Group ID: Policy Holder: Member ID: Parent/Guardian Signature Date

4 A Note From the Director Regarding Injuries Received at School It has been our school policy to call you when your child gets hurt at school if it s more than tender loving care, washing and a band-aid can cure. We will call you if your child has had her/his head bumped in any way, if another child has bitten your child and broken the skin, if we even think a cut may need stitches or that a bone is broken. The latter mentioned injuries are few and far between but at times do happen. We are trained in First Aid and CPR, so we administer immediate care. If anything else is needed, we either call you or emergency medical assistance. Please check the appropriate box below indicating your preference for notification regarding boo-boo s then sign and date. We are required to have this form on file for each child attending the school. Thank you. Brandi Specia School Director Child s Name: Parent s/guardian s Name: Check One: Call me only for emergencies (current policy) Call me for every injury- phone# alternate phone# Parent s/guardian s Signature Date

5 Laurel Heights UMC Weekday School 234 West Mistletoe San Antonio, Texas Fax EMERGENCY INFORMATION Child sname Last First Middle Name Used Male Female Weight Height Date of Birth Allergies (if NONE, Please write NONE ) Medical conditions, restrictions or needs (if, NONE please write NONE ) Parent s/guardian s name Home phone Work Phone Cell phone address Home address Zip Business name Address Parent s/guardian s name Home phone Work Phone Cell phone address Home address Zip Business name Address I give consent for the Weekday School to secure any and all necessary emergency care for my child and will assume responsibility for all fees incurred. In the event I am unavailable to make emergency medical arrangements, I authorize any Laurel Heights Weekday school personnel to contact or take my child for medical treatment and release my child s medical information to the Emergency Medical Service (EMS) as well as: Physician s full name Address Zip Phone Hospital Address Zip Phone Health Insurance: Insurer s name Prefer not to answer Who do we call in case of emergency and parents cannot be reached? I give my consent for the following emergency contacts to have access to my child s medical information: Name Address Phone Relationship Name Address Phone Relationship Name Address Phone Relationship I understand that I must drop off my child in the presence of a staff member and notify a staff member when picking up my child. I understand my child will be released only to me (parent/guardian) or to one of the following persons, including car pool: (picture ID will be required) Name Address Phone Relationship Name Address Phone Relationship Name Address Phone Relationship Parent/Guardian Parent/Guardian Both Parent/Guardian signatures are required to verify all of the above information and consent authorizations. Date

6 I understand that registration and supply fees are non-refundable and are payable to Laurel Heights U.M.C. Weekday School upon enrollment of my child and these fees are non-refundable. The payment of the above fees reserves a place for my child in the school. Thereafter, for the remainder of the year, August through May. Monthly tuition is due by the first day of the month. If the first day of the month is a holiday or weekend, then the payment is due the following school/business day. Summer tuition is due by the first day of the session. There are no refunds, deductions or make-up absences. Late payment fees are assessed as stated in our Parent Handbook. PARENT AUTHORIZATION Child s Name: Child s Password*: (see explanation on reverse) Persons bringing the child must sign the sign-in/sign-out sheet and make sure that a staff member is aware of the child s arrival; persons picking up the child must sign the signin/sign-out sheet upon the child s departure and make sure the staff member is aware child is leaving. Signature of Parent or Guardian I will inform other adults who drop off my child that they will be required to sign the signin/sign-out sheet ; I will inform other adults who pick up my child that they will be required to present a picture ID for photocopying, provide my child s password and sign the signin/sign-out sheet. I understand only adults who have been listed on my child s admission information form will be able to pick up my child after presenting the proper verification. Signature of Parent or Guardian I authorize Laurel Heights U.M.C. Weekday School to take photographs and video of my child for school use. I authorize Laurel Heights UMC Weekday School to take photographs of my children for use on the school s Facebook page. I understand that my child s name will not be written with the photograph. _ I authorize Laurel Heights UMC Weekday School to take photographs of my children for use on the school s link from the church s website, and the school website. I understand that my child s name will not be written with the photograph. _ continued on reverse

7 I authorize my child s teacher, the administration of Laurel Heights U.M.C. Weekday School, licensing agencies (TX Dept. of Family and Protective Services and San Antonio Metropolitan Health Dist.), and the accrediting organization (National Association for the Education of Young Children) to read my child s file of enrollment papers, including health information on file, as needed for educational, safety, licensing, and accrediting purposes. I authorize Laurel Heights U.M.C. Weekday School to post my child s allergies/medical conditions/special instructions in each classroom the child attends throughout the day. I hereby consent to have my child participate in walks or rides away from the school grounds to nearby points of interest under the careful supervision of the teachers or participating volunteers. A criminal history check is required for all staff, parents and volunteers who attend field trip and are alone with children) YOU WILL BE NOTIFIED IN ADVANCE OF ANY FIELD TRIPS. Special instruction I understand that Laurel Heights UMC Weekday School will provide snacks for my child. I am responsible for providing my child s lunch and I will not hold Laurel Heights UMC Weekday School responsible for its nutritional value or for meeting my child s daily food needs. Signature of Parent or Guardian If my child needs mosquito repellant or sunscreen or any type of medication during school hours, I will apply them BEFORE I drop my child off at school. I understand that if anything needs to be applied to my child at school by any caregiver or a parent/guardian I will fill out and sign the appropriate authorization forms in advance. I give my consent for my child to participate in running through the sprinkler during warmer months. * We have instituted a safety measure whereby each child has a password. Where indicated on reverse, please write a word that anyone picking up your child will be able to tell us. This password will remain in your child s file in the school office (and in a file kept in the after school classroom, for a child staying after 3:00.) If you or the person who regularly picks up your child is unable to pick up your child, you may call or write a note to the school granting special permission for another person to pick up your child. We will confirm that this person is authorized to pick up your child as she/he will know your child s password and can provide a picture ID.

8 CHILD INFORMATION FORM Child s Name D.O.B. Birthplace Parent/Guardian # 1 Name: Parent/Guardian #2 Name: Siblings names/ages: Other members of household: Name/age/relationship: Days scheduled to attend: Previous school(s): CHECK ALL OF THE FOLLOWING THAT APPLY TO YOUR CHILD: wears diapers is potty training needs assistance using the toilet uses toilet independently Remarks: needs help changing clothes changes clothes independently naps: a.m. naps: p.m. does not nap Remarks: previous serious illness injuries or hospitalization during past 12 mos. has fears (specify): has allergies (specify): dislikes particular foods (specify): drinks from a bottle drinks from a sipper cup requires special medical care (specify): has a history of physical impairment (specify): has a visual impairment has a hearing impairment (specify): has a developmental delay has a speech problem/delay (specify): is currently taking a long-term/maintenance prescription medication (specify): other important information about your child? FAVORITE PLAY EXPERIENCES OF CHILD: Games Toys Outdoors Books Travel TV/Movies Signature of Parent/Guardian Date continued on reverse

9 FAMILY INFORMATION FORM & Questionnaire Parent/Guardian #1 Name Date of Birth Birthplace Occupation Bus. Address Daytime Phone Cell Parent/Guardian # 2 Name Date of Birth Birthplace Occupation Bus. Address Daytime Phone Cell Family Church Affiliation/Religious Preference? Are parents living together? If not and you would like copies of newsletters, notes, and /or bills sent to a separate address, provide that address here: Please briefly describe your family structure. (for example, our family has one mother, one father, and 2 children etc) Was this child adopted? If so, does the child know? What do you hope this child will gain from his/her experience at Laurel Heights Weekday School? Is there any information about your family that we need to know that will help us better meet your family s/child s needs? Such as: discipline/child rearing practices, primary languages spoken at home. Tell us about your family s cultural background? How do you identify yourself racially? Why did you choose Laurel Heights for your family? Is there anything we do at Laurel Heights that runs counter to your beliefs?

10 Discipline and Guidance Policy for Laurel Heights Weekday School Discipline must be: 1. Individualized and consistent for each child 2. Appropriate to the child s level of understanding 3. Directed toward teaching the child acceptable behavior and self-control. A teacher/caregiver may only use positive methods of discipline and guidance that encourage self-esteem, self-control, and self-direction, which include at least the following: 1. Recognizing appropriate behavior instead of focusing only upon unacceptable behavior 2. Reminding a child of behavior expectations daily by using clear, positive statements 3. Redirecting behavior using positive statements 4. Using brief supervised separation or time out from the group, when appropriate for the child s age and development, which is limited to no more than one minute per year of the child s age. There must be no harsh, cruel, or unusual treatment of any child. The following types of discipline and guidance are prohibited: 1. Punishment associated with food, naps, or toilet training 2. Pinching, shaking, or biting a child 3. Hitting a child with a hand or instrument 4. Putting anything in or on a child s mouth 5. Humiliating, ridiculing, rejecting, or yelling at a child 6. Corporal punishment or threats of corporal punishment 7. Subjecting a child to harsh, abusive, or profane language 8. Placing a child in a locked or dark room, bathroom, or closet with the door closed 9. Requiring a child to remain silent or inactive for inappropriately long periods of time for the child s age. My signature verifies I have received and read a copy of this discipline and guidance policy. Signature Date Check one please: Parent/Guardian employee/caregiver

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